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SIOG 2016 Milan

The 2016 edition of the SIOG Annual Conference took place in Milan, Italy from November 17-19. We would like to thank all participants, faculty members and industry partners for their participation which contributed to the huge success of our conference.

SIOG 2016 Awards

The SIOG 2016 Paul Calabresi award was given to Reinhard Stauder (AT) Read MoreThe SIOG 2016 National Representative of the year was given to Lore Decoster (BE). Read More The 2016 BJ Kennedy award for best poster was given to Daisuke Makiura (JP) - Sarcopenia is associated with an unplanned readmission and worse survival following esophagectomySIOG 2016 BJ Kennedy best poster.pdf The SIOG 2016 Nursing & Allied Health investigator award was given to Fay Strohschein (CA) - Choosing to trust: cancer treatment decision making from the perspective of older adults with colorectal cancer. Read More The SIOG 2016 Young investigator award was given to Zachary Horne (US) - National patterns of care and outcomes of oropharyngeal squamous cell carcinomas in patients over 70. Read More

SIOG 2016 Session slides

The session presentations are now available for SIOG members and SIOG 2016 participants. SIOG members can access them by logging in their MySIOG acccount (the presentations are located under the member news section). SIOG 2016 participants can contact the SIOG Head Office at info@siog.org to obtain the link for the slides.

SIOG 2016 Scientific programme

SIOG 2016 Photos

Selected photos taken during the conference are available here. (Dropbox)

SIOG 2016 In the media

had conducted a series of interviews of SIOG key opinion leaders and conference speakers. Watch the videos.ecancer is the leading oncology channel committed to improving cancer communication and education with the goal of optimising patient care and outcomes.

This service has been kindly supported by an unrestricted grant from MSD.

All abstracts of the 16th Annual conference of the International Society of Geriatric Oncology were published in a supplement of the Journal of Geriatric Oncology (JGO), official journal of SIOG.

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has conducted a series of interviews of SIOG key opinion leaders and conference speakers. Stay informed about the latest in Geriatric Oncology and watch the videoshere.ecancer is the leading oncology channel committed to improving cancer communication and education with the goal of optimising patient care and outcomes.

This service has been kindly supported by an unrestricted grant from

Industry partners

The International Society of Geriatric Oncology thanks all sponsors for their support towards the 2016 Annual Conference.

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Educational grants

We gratefully acknowledge the following companies for their unrestricted educational grants towards our scientific programme.

This session has been supported by an unrestricted educational grant by Astellas.

Celgene Sponsored SymposiumNanoparticle Albumin Bound (nab) paclitaxel and its role in the elderly: Moving from clinical studies to clinical practice

Saturday November 19, 10:30-11:30 - Washington B

Objectives- Explore the challenges in the management of elderly cancer patients and the opportunities to optimize therapy and improve outcomes. - Review the experience on treating elderly patients with nab-paclitaxel across the approved indications in pancreatic, breast and lung cancers.

SIOG 2016 CME Accreditation

The SIOG 2016 Annual Conference was granted 16 European CME credits (ECMEC) by the European Accreditation Council for Continuing Medical Education (EACCME).

European accreditation European Accreditation is granted by the EACCME in order to allow participants who attend the above-mentioned activity to validate their credits in their own country.

Accreditation statement Accreditation by the EACCME confers the right to place the following statement in all communication materials including the registration website, the event programme and the certificate of attendance. The following statements must be used without revision:

The 'SIOG - International Society of Geriatric Oncology' (or) '16th Annual Conference of the International Society of Geriatric Oncology (SIOG)' is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS), www.uems.net.

The '16th Annual Conference of the International Society of Geriatric Oncology (SIOG)' is designated for a maximum of (or 'for up to') 16 hours of European external CME credits. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.

Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME credits to an equivalent number of AMA PRA Category 1 Credits™. Information on the process to convert EACCME credit to AMA credit can be found at www.ama-assn.org/go/internationalcme.

Live educational activities, occurring outside of Canada, recognized by the UEMS-EACCME for ECMEC credits are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada.

EACCME credits Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. The EACCME credit system is based on 1 ECMEC per hour with a maximum of 3 ECMECs for half a day and 6 ECMECs for a full-day event.

Milan 2016 a global success

With a record number of participants drawn from 42 countries, the professional, geographical and cultural diversity at this year’s annual conference reflected its theme of "Geriatric Oncology: a multidisciplinary approach in a global environment”. To be practice changing, let us be practice sharing; and there were great opportunities to exchange ideas.

The meeting heard of experiences from Hong Kong to French Guiana, and from Norway to Morocco.

As well as being global, geriatric oncology is also mainstream. Given cancer demographics, every adult oncologist has to know about geriatrics. And, given the high proportion of elderly people who develop cancer, every geriatrician has to know about oncology. This was a point emphasised by Stuart Lichtman (New York, USA), SIOG’s incoming president. The “silver tsunami” in Japan, where 27% of the population is now aged over 65 years, shows us the future of most nations.

Time to take a stand

The large overlap between specialties demonstrates the need for geriatric assessment of elderly cancer patients. It is time we stopped being apologetic about this, said Marije Hamaker (Utrecht, The Netherlands). We should no longer say that geriatric assessment is time consuming and start saying that it is time well spent.

If we can pay thousands of dollars for mutation analysis or sophisticated imaging, and tens of thousands for targeted therapy and surgery, we can surely spend time with patients to establish whether a treatment is likely to help or harm them. Twenty minutes can gain you a lot of important information. GA is not costly in comparison with other techniques used to guide management.

Updates around oncology

Surgeons recognise the importance of perioperative management of elderly patients, and through the Enhanced Recovery After Surgery (ERAS) approach, of post-operative care. Attention is now turning to assessing and optimising patients’ preoperative status.

Minimally invasive surgery is reducing trauma, pain and need for narcotics, and so the duration of hospitalisation. Alternatives to surgery being explored in high-risk elderly patients include focal ablation and chemoembolisation.

Drug treatment: Loïc Mourey (Toulouse, France)

Recent phase III data suggest that the benefits of new immunotherapies (particularly monoclonal antibodies directed at PD-1 and PD-1L) extend to elderly patients with a variety of tumours, including melanoma, bladder and renal cancer, and that autoimmune toxicities are no greater than in younger patients.

Highly promising progress continues with small molecule, tumour-targeted agents. A striking example is CLL, where older patients are finding effective treatment accompanied by relatively low levels of severe adverse events. These developments are outlined in the most recently published SIOG guidelines by Stauder R et al, Annals Oncol 2016.

Compared with conventional radiotherapy, intensity modulated RT reduces bowel complications in patients treated for prostate, rectal and cervical cancer and reduces side effects of treatment for head and neck tumours.

With increasing adoption of stereotactic RT in community practice, many elderly NSCLC patients find an alternative to surgery.

Carrot or stick: ensuring the elderly are enrolled in trials

As Gouri Bhattacharyya (Kolkata, India) outlined, the recent history of medicine has seen a shift from eminence-based practice (we believe the most senior) through eloquence-based practice (we believe the most skilled in argument) to evidence-based practice. And in this context the randomised controlled trial is king.

The problem is that while most patients with cancer are elderly (and many of them frail), most patients in pivotal trials are not. So we lack robust evidence on which to decide treatment. How to resolve this situation was the subject of a lively round table discussion chaired by Etienne Brain, retiring president of SIOG.

Some supported the view that lack of evidence in the elderly will only be resolved by legislation that requires drug companies to run studies exclusively in patients aged over 65, and/or to include enough elderly patients in trials to allow subgroup analyses by age. Precedents for this approach are found in the laws that required trials in paediatric populations, and those that ensured equitable representation of women and African Americans in clinical studies.

Others argued that incentives such as patent extensions to reward adequate trials may be sufficient.

And, unless we mandate the inclusion of frail patients -- as well as elderly ones -- there is the risk that enrolment criteria unrelated to age will continue to ensure that trial patients are unrepresentative of the wider cancer population in physiological function and the prevalence of comorbidities.

The debate extended to the inclusion in trials of endpoints of particular relevance to the elderly -- notably those relating to functioning, quality of life and cognition -- and to whether non-randomised observational studies can provide meaningful information on efficacy and tolerability. These discussions are far from finished.

Monitoring and telemedicine

Geriatric assessment at baseline can predict outcome but does not monitor the function of a patient during treatment. Health professional and patient views are helpful, but not necessarily reliable or sensitive – or practical – as a way to chart change over short periods. The question of whether technology can help was considered by Aresh Naeim (Los Angeles, USA).

Sensors incorporated into a device as small as a watch already provide information about the wearer’s degree of activity, position, heart rate, skin conductance and temperature, and blood oxygen saturation. Any device that provides recommendations about treatment will be subject to strict regulation. But devices that do no more than monitor and report a patient’s condition – probably linked to smartphones -- should gain approval more easily. They may have great potential in monitoring function and in the early detection of toxicities in vulnerable people. Sensors in clothing and implanted in the body are also being studied.

Guidelines

Developing guidelines for the treatment of elderly patients with cancer is one of the most important of SIOG’s roles.

Guidelines on prostate, bladder and HER2-positive breast cancer are close to submission and versions in draft form were presented at the meeting.

Prostate: The new guidelines (described by Jean-Pierre Droz, Lyon, France) are likely to differ from previous versions in suggesting that the cognitive function of patients is evaluated at an early stage so that their treatment preferences can be established. The guidelines will also suggest the early introduction of palliative care, as well as exploring the implications for treatment of advanced disease using the new agents abiraterone, enzalutamide, cabazitaxel and radium 223.

Bladder: SIOG guidelines (presented by Nicolas Mottet, Saint Etienne, France), will recognise that data on older patients are – as usual – in short supply but suggest that bladder-sparing strategies may be an underused alternative to cystectomy in muscle-invasive bladder cancer.

Her2-positive breast cancer: The possibility of compromised cardiac function – either pre-existing or likely to be induced by treatment -- is of crucial importance. Etienne Brain (France) considered the potential of weekly paclitaxel in combination with trastuzumab in adjuvant therapy for frail elderly patients. In metastatic disease, docetaxel (with G-CSF) plus trastuzumab plus pertuzumab is standard first-line treatment in fit elderly patients while T-DM1 is recommended for second or later lines in the fit elderly.